Provider Demographics
NPI:1578325957
Name:STENGEL, JASMYN VALLECILLO
Entity Type:Individual
Prefix:
First Name:JASMYN
Middle Name:VALLECILLO
Last Name:STENGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JASMYN
Other - Middle Name:IONA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5801 WASHINGTON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4057
Mailing Address - Country:US
Mailing Address - Phone:262-884-9734
Mailing Address - Fax:
Practice Address - Street 1:5801 WASHINGTON AVE STE 110
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4057
Practice Address - Country:US
Practice Address - Phone:262-884-9734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist